Acute Myelopastic leukemia

I have a patient.
He is a 51 y.o supernice gentleman.
He is diagnosed with AML in February/March 2010.
He was admitted last week for his 3rd chemo.
His initial WBC was 8.9. After 5days of admission/chemo; his WBC is 1.
His BP is in lowish side.
He has temperature of 39.5.
He is in sepsis.
But that was not things that i want to talk about.
This pakcik, made me cried few times.
I was so attached with him eventho i just knew him for a week.
He is married with 3children. The eldest is 15y.o and the youngest is 10y.o.
He was a tukang rumah before he got sick.
He was unable to work for the past few months for his illness.
He is currentlty under Kebajikan Masyarakat and received at most Rm300 a month.
When we saw him in d hospital prior to his admission for chemo, my specialist asked him;
"Pakcik, ni nak balik rumah ni pakcik nak naik ape?"
"xper doctor. Nanti pskcik cari kereta tambang"
"Xper pakcik. Pakcik ade duit ke tu?Kalau xder ssye boleh organisekan ambulance utk pakcik".
"xper doctor. Biar orang yang lagi susah dari saye naik. saye boleh cuba usahakan"

Then he went back with the taxi. He was again admitted for chemotherapy. When i wanted to give his chemo-cytarabine high dose, he asked me;
"Doctor, agak2 lepas ni pakcik boleh makan x?skarang ni rase tak sedap dah. lepas chemo lagi teruk. Dah la makanan hospital ni tawar rasenye"
"xpe pakcik insyaAllah. Saye bagi pakcik ubat kumur utk ilangkan rase sakit2 dalam mulut pakcik tu.Pastu pasal makan tu pakcik kirim kat adik2 student nurses ni. Saye sendiri kirim kat diorg je."
"takpelah.esok pakcik kirim sebabnya orang rumah pakcik takleh dtg 2 hari ni. takde orang nak jaga anak2 kat rumah dan anak2 pakcik ada aktiviti dekat sekolah dia"
Then the next day i came he asked me for a sweets. He was nauseated even after given him IV Kytryl(5HT3 antagonist).I gave him few and he wanted to pay for that.
Tak tau kenapa tapi sangat tersentuh when pakcik tu keluarkan purse dia utk bayar gula2 tu. Gula2 tu 20sen je mungkin harga die tapi die still nak bayar. Macam kalau orang lain bagi rm 5 pon tentu xdenye nak bayar kan. Tapi utk orang susah macam dia yang duit tak seberapa rm0,20 pun masih mahu membayarnya. I dont know how to express it tapi macam dia orang yang jujur dan baik hati la.
Then the next day i datang review him again. He told me regarding his children and while was telling me the stories about his children he was sheding his tears. Statement yang saya akan ingat sampai bila2;
"kadang2 bila terfikir saya ni takk lama serba tak kena saya. Anak2 kecik lagi. Yang bongsu tu kalau cakap pakcik nak masuk hospital nangis2 taknak kasi pakcik pergi. Yelah die kecik lagi mungkin xfaham yang dalam hidup ni semua akan mati. Saya tak tau macam mana diorang nak makan lepas ni. Yang orang rumah pula tak tau nak buat kerja sangat, Kalau x boleh jual2 kuih ke. Anak pakcik pandai2. CIkgu sayang diorg. Sedih kalau tgk kadang2 diorg makan xcukup lauk. Tapi tu yang mampu pakcik dapat sekarang ni."
And guess what?keluar je from bilik pakcik tu i went to the toilet and cried. Macam rase jahatnyeeeee diri ini selama ini. Makan beli lauk banyak2 then x abis. Elektrik pakai x berjimat. Baju tak suke buang.=(

Sorry.Mungkin ade yang bosan dengan entry yang xde kaitan sangat pon dgn ape2 n mungkin xdifahami tapi saya rase nak menulisnye. I dont think im capable of doing oncology. I cant control my own feelings. I am so attached to them. I was enthusiastic enough to find the patient;s hse just to give him his medications. I scold people for lambat ambik chemo drugs. I gave my phone numbers to my patient just so they could contact me if anything happens and so many other things that i have done just because i am emotional and attached to them. Mungkin terover EMPATHY.huhu

adamayaa

Falling in love is d easist thing to do.
and letting go is d most difficult thing to do.
somehow when i watched adamaya and when i heard already gone by kelly and separuh jiwaku pergi by anang i felt sorry to myself.
i cant explain why but it breaks my heart.:(

=)

Pls, pls,
ramai la new HO masuk HRPZ 2.
pls
pls.
sangat penat.
kami hanya ade berape ketul H.O je skang.
tu tak tolak yang sesuke hati nak meng EL kan diri.
penat.
FULL STOP.
Tapi tadi postcall pon sempat lepak2. Mengswimmingkan diri kat kondo, melepakkan diri makan2 kat tepi sungai dan juge membowlingkan diri.
Ok la tu kan?haha.
Anyways sape nak kawen june cepat booked. dah more than 10 ni wedding invitation i dapat for june ni.hahaha

A patient

I have a patient.
She is a 16 y.o school girl.
She presented with a mass in her abdomen 5months ago.
She only noticed the mass in her abdomen only few weeks prior to hosp admission.
Upon admission, the mass is about uterus at 28weeks size.
A very filthy big mass for a 16y.o pleasant girl who just weighted 30kg.
An urgent ultrosound made upon d admission and malignancy detected in her ovary. The mass was so big that we could not appreciated whether it came from the right or left ovary.
A very ugent operation organised for her.
She went into d operation. However d tumour couldnt be removed as it was attached to underlying structure and was so friable.
She developed severe haemorrhage with more than 2litres blood loss.
She was sent to the ICU for close monitoring.
Then she was transfer out to gynae ward.
Her condition worsen on that time.
There was a time when she suddenly cried and started to mumbling things as if she was going to die.
One day when i was oncalled she suddenly collapsed and was transfer out to ICU again.
Before she was t/o to the ICU she specifically asked me to accompany me to the ICU and made me promised to visit her everyday while she lives.
Luckily, the tumour that she has is responsive to chemotherapy.
She underwent few chemo cycles and 2days ago she just had her 2nd operation- Total Abdominal Hysterectomy. That filthy big tumour shrunk with the chemo regime and managed to be removed with hysterectomy.
And she recovers very well.
I went to visit her and she gave me a smile that made me so contented, satisfied and gladful.
Her smile provoked undescribable feelings in my heart that made me forgot all the stresses and sadness that i had so far in my journey as a doctor .=)

i love u pakcik.hahaha

haha thanks encik hubby.hehe
anyway im in my 3rd posting already.
time flew by so quickly.
cant believe that its almost a yr dh saye sudah jadi doctor.
im in medical posting at d moment.
jaga ward lelaki
and jaga cubicle org xnak jaga.
HIV +ve patients and TB patients.
aaa xsuke.
sangat~
most of them pon IV drug user.
line die nak dapat masuk branula sangat la susah.
pg tadi mencabar kesabaran la
vein tangan die gune sume dh utk drugs abuse.
mmg die sendiri admit xde tempat utk cucuk.
kaki die lak satu tu amputated dah
and the other one lak mcm baru healed from osteomyelitis post plating(infected implant)
so worst come to worst, i'd inserted branula at his thumb!!!
siaptanye opinion die dulu..
tapi cuak gakkkkkk masa nak insert.sebab rs die mcm boleh buat anything je sebab tangan die sebelah je kene gari.hahaha
masuk posting medical ni lunch mmg jgn berharap sangat lah kan.
U r so damn lucky to have time for a lunch!
hahhaa.gile x?
seb baek i berjaya paksa my bibik to cook for me nasi goreng everyday for my breakfast.
xpe. kejap je lagi then 2 yrs then i boleh quit keje n jadi lecturer or businesswoman.hahaha.dh xrase nak jadi specialist ID.haaha.
kadang2 keje doctor best gak esp when org cakap time kasih or dengar ayat mcm sorang pakcik ni cakap(he's not even my patient!)
"doctor, pakcik nak cakap sket kat doctor. 50tahun pakcik berulang alik kat hospital masuk keluar hspital tapi xpenah pakcik jumpe doktor perempuan seaktif doctor. cekap and cepat buat keje.doctor teruskan keje mcm tu ye doctor.bagus utk negara"
i was so impressed and terus bersemangat utk keje.
ok nak makan.lapar.hahaha.

mY Lovely Wife...

hahahah...sayek curik password my wife..huhuhu

anyway..saje nak menyibuk kat blog my darling neh...nampak selalu gak die tulis mende ni..walau diriku ini tidak pandai la sangat menjadi seorg blogger ni hihih..

mmm sekarang ni da 3 bulan dah kitorg kawin......alhamdulillah...syukur pada Allah SWT atas segala rahmatnya....rase hepi sgt2...walau mase awal2 kawin dulu kitorg da kene pisah...nak kene g tanah merah la...tapi yg lebih kelakarnyer adalah bile aina balik ke KB ...now its my turn pulak nak kene g tanah merah hihihi...pejam celik pejam celik dah tinggal lagi 1minggu kat sane..then balik KB....horeee....pastu yg lagik best...dtg dok 1 department lagi ghagagagga.....

dulu kat tanah merah pun...tiap kali aina oncall..sure diriku dtg teman die...mane tak nyee...quartes tu seraM GILE..Jauh la jugak dari spital..pastu...ade ke banduan pulak terlepas tak situ,,,huhuhu,,,,sape tak sayang bini oii,,,,cantik n cute lak tu ahhahaha...

eh jap..sebebnarnyer...ape tujuan menyibuk sini neh..huhuhu..mm nak cakap ...yang SAYA SAYANG AWAKKKK...!!!!!HePi MoNThaVassaRyyy.... (adiah nnt kumpul eh...hihihi)..

okla da tak nak nyibuk,,,nnt nak tulis lagi,,,,,nak g semayang jumaat..

mmmuahssss...

LUV U ALWAYSZZZ..

ur HubBy

Hospital Tanah Merah

Im enjoying my life in Hospital tanah Merah except for its creepy quarters (at nite).
I dh oncall 3kali kat situ.
And tido xpenah terganggu.
Malam after buat pm review ( tu pun selected patients from 12 patients) i dh xde keje dh.
usually xde kes dh after that.
Penah sekali je la kene keluar pergi wad kul 1pagi.
Tu pon sebab nak insert branula.
Kalau x mmg xyah. Nurse dh xleh buat dh sebab tu die panggil.
Kalau x nurses kat situ mmg superb punye baek hati.
Boleh tolong kite la.
Kalau pagi2 lak, bloods xyah risau.
Unless patients yg mmg susah baru die call kite.
Kalau x adik2 ade ramai yg nak tolong amikkan.hahaha
sekali ngan cikgu diorg amikkan.
hehe.:p
and guess what?
ari yg bukan klinik by 930am i dh jobless.
kacau2 kawan2 surgery, medical sebab we r sharing the same ward.
There is only 1 male ward, 1 female ward and 1 paeds ward.
Owh ong juge. tapi tu tolak tepi lah.hehe
Mcm 2 days ago. I was oncalled.
I tido kul 930pm and x bangun2 dh sampai pagi utk morning round lak.
heaven la.
cume nak kene berulang kb tm tu je.
Tapi not that bad. I penah bawak 140/160 ( xtau la brape banyak saman dpt bulan ni) and dapat sampai in 20minutes!!hahaha.
Kalau x normally 40-50mins.
Kalau petang jem sket boleh sampai 1hr.
Tapi keje bukan banyak pon even BD round.
Patients pon ade la dlm 14-15.
1/8 dari patients kat HRPZ(2).
and lagi best kan sebab sume org pon baek gile.
Senang nak mintak tolong.
Specialist pon baek.
MO pon baek.
MA pon baek.
Nurses pon baek.
I rs i nak apply district dh pasni.hehe.:p

P/s : Pija aha die dh start sending housmen for a month kat district hospital. Tapi xsume posting la. diorg ckp if dh penah pergi the likelihood utk pg the next posting tu krg. Tapi best pija dok district. Eventho oncall EOD pon (Every other day) tapi xpenat. hehe.=)

Haemophilia

Im upset. Really am.
Esok Majlis Menyambut Menantu.
Sunday.
Ari keje n sekolah untuk THE WHOLE KELANTAN.
So only my parents and FEW of my aunties will be there.
My siblings?
NON!!!!
Im so damn upset.
Macam blaming everyone juge.
And u knw what?
Die mcm patient with haemophiliakan.
Dh la ade higher tendency untuk bleeding kan?
pastu ditambah dengan heparin solution.
What do u expect kan?
bleeding ++ +++++++++++